J Korean Ophthalmol Soc.  2013 Mar;54(3):513-517. 10.3341/jkos.2013.54.3.513.

Complicated Ophthalmopathy in Herpes Zoster Ophthalmicus Including Vitreous Opacity, Retinal Hemorrhage and Optic Neuropathy

• Kim M
• Choi MY
• Chae JB

• KMID: 2216775
• DOI: http://doi.org/10.3341/jkos.2013.54.3.513

Abstract

PURPOSE
To introduce a case of complicated ophthalmopathy in herpes zoster ophthalmicus including vitreous opacity, retinal hemorrhage and optic neuropathy having components of anterior ischemic optic neuropathy and optic neuritis.
CASE SUMMARY
A 59-year-old man visited our clinic because of visual disturbance in the right eye which occurred after right facial pain and vesicles. There were inflammatory cells in the anterior chamber, retinal hemorrhage in the retina and vitreous opacity was found. Track-like high signal intensity along the right optic nerve was found on T1 MRI. Partial filling defect of optic disc was observed on fluorescein angiography (FAG). The patient was diagnosed with herpes zoster ophthalmicus complicated by anterior uveitis and optic neuropathy having components of anterior ischemic optic neuropathy and optic neuritis. The patient was started on intravenous acyclovir at a dose of 10 mg/kg every 8 hours for 5 days and Herpesid eye ointment 5 times daily. After the initial treatment, oral acyclovir 400 mg was given 3 times daily for 14 days. Skin symptoms and fundus findings improved but the visual acuity did not improve because of optic atrophy.
CONCLUSIONS
Ophthalmopathy including anterior uveitis, vitreous opacity, retinal hemorrhage and optic neuropathy having components of anterior ischemic optic neuropathy and optic neuritis should be considered in herpes zoster ophthalmicus patients.

Keyword

Anterior ischemic optic neuropathy; Herpes zoster ophthalmicus; Retinal hemorrhage; Vitreous opacity

MeSH Terms

Acyclovir
Anterior Chamber
Eye
Facial Pain
Fluorescein Angiography
Herpes Zoster
Herpes Zoster Ophthalmicus
Humans
Optic Nerve
Optic Nerve Diseases
Optic Neuritis
Optic Neuropathy, Ischemic
Retina
Retinal Hemorrhage
Retinaldehyde
Skin
Uveitis, Anterior
Visual Acuity
Acyclovir
Retinaldehyde

Figure

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  Figure 1. Skin eruptions corresponding to the dermatome of the right ophthalmic branch of the trigerminal nerve are seen.

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  Figure 2. Multiple round-shaped retinal hemorrhage, flame-shaped retinal hemorrhage and vitreous opacity are seen.

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  Figure 3. Blocked fluorescences at multiple round retinal hem orrhage sites are seen. Filling defect is seen at the disc.

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  Figure 4. Track-like high signal change along the right optic nerve on T1 M RI.

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  Figure 5. Improving state of multiple retinal hemorrhages. Pale disc and optic atrophy are seen.

Reference

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